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Study Describes Long-Term Outcomes Of Pediatric Pulmonary Embolism

Up to nearly one-third of pediatric patients with thromboembolic pulmonary embolism (PE) experienced abnormal functioning, which was more common among those with underlying conditions, according to the results of a cohort study published in the journal Blood. However, post-PE syndrome was uncommon and rarely persisted.

The study analyzed data from 150 patients aged 0 to 18 in the Thrombosis Database at SickKids who were diagnosed with acute PE and who survived for at least 6 months after diagnosis. The median follow-up was 521 days with a median of 3 outpatient visits.

At baseline, the median age at diagnosis was 16 years and 47% of patients were male. There were 61% of patients with an underlying condition, which included autoimmune disease among 22%, cancer among 13%, infectious disease among 5%, and cardiac disease among 5%. There were 17% of patients with more than 1 comorbidity.

Hospital acquired PE was more common among patients with an underlying condition, with a rate of 63% compared with 29% of patients without an underlying condition (P <.001). In contrast, oral contraceptive use was present among 78% of patients without an underlying condition compared with 30% with a condition (P <.001).

The most common treatment was anticoagulation, which was used among 82% and 81% of patients with or without an underlying condition, respectively. Anticoagulation plus thrombolysis/thrombectomy was used in 13% and 19% of patients, respectively.

The PE was not resolved at follow-up among 32% of patients with an underlying condition and 26% of patients without (P =.47). Recurrence was more common among patients with an underlying condition at 13% compared with 1.7% among patients without (P =.016). The rate of death was 6.5% and 1.7%, respectively (P =.25).

Patients with or without an underlying condition demonstrated transient abnormalities after PE, which included dyspnea or increased work of breathing in 18% and 21% of patients, respectively (P =.84) and abnormal echocardiogram findings in 9.3% and 1.9%, respectively (P =.11).

Abnormal functional findings were seen in up to 20% to 30% of children diagnosed with thromboembolic PE, most commonly ventilatory impairments, impaired aerobic capacity, exertional dyspnea, and DLCO impairment.

The rates of chronic dyspnea were 7.6% and 5.2% in patients with or without an underlying condition, and the rates chronic abnormal echocardiogram findings was 5.8% and 1.9%, respectively. Chronic thromboembolic pulmonary hypertension and post-PE cardiac impairment each occurred in 1 patient with an underlying condition.

Post-PE functional impairment was evident among 9.7% of patients with an underlying condition and 7.1% without (P >.99). Patients with underlying conditions were more likely to demonstrate diffusing capacity of the lungs for carbon monoxide (DLCO; P =.001) and ventilatory (P =.049) impairments compared with patients without.

At follow-up, maximal oxygen consumption (VO2) and abnormal VO2 peak z score were higher among patients with underlying conditions (P =.042 and P =.040); however, there was no significant difference in percent peak heart rate, peak workload, peak oxygen saturation, or exercise desaturation.

"Abnormal functional findings were seen in up to 20% to 30% of children diagnosed with thromboembolic PE, most commonly ventilatory impairments, impaired aerobic capacity, exertional dyspnea, and DLCO impairment," the authors concluded in their report.

This article originally appeared on Hematology Advisor

How Technology Is Bringing Cardiology, Cardiac Surgery Together

New technological developments in the cardiology field have increased collaboration to improve patient care, according to one cardiac surgeon.

Frank Fazzalari, MD, who is the chief of cardiothoracic surgery at Troy (Mich.) Beaumont Hospital, recently connected with Becker's on the state of the cardiac surgical and cardiology fields.

Note: Responses were lightly edited for clarity and length.

Question: What are the biggest challenges facing the cardiology and/or cardiac surgery field?

Dr. Frank Fazzalari: A lot of cardiac surgeons now are hospital-affiliated, with the majority of them probably as part of a hospital-employed medical group. That has happened over the past 15 years or so, which has led to there being very little purely private practice cardiac surgical groups left in the country. I think that's a little different in cardiology, but my guess is over time that they may experience the same sort of pressures as we have. I think that's one of the pressures that have caused cardiac surgeons now to be mostly somewhat financially affiliated with health systems.

The other pressure, I think that's more toward cardiology specifically, is the advent of freestanding cath labs. That's a new thing that's come up where groups or entities or cardiologists are able to have their own cath labs outside the hospital. So that gives them even more market power over hospital systems, which is a change in the market dynamics. That is a negative pressure on hospitals because they are potentially losing some of that revenue. The same things are happening in surgical subspecialties like general surgery and gastroenterology; a lot of those have been shifted out of the main hospital and into privately owned surgery centers. This is just kind of another example of that in the cardiology space. Obviously, that's a negative for the hospitals that lose out on that revenue and those patients.

Q: What is one positive trend you have seen in the industry?

FF: Advancements in technology, such as transcatheter aortic valve replacement, have further incentivized cardiologists and cardiac surgeons to work more closely together, which is a positive for patient care. Before TAVR, in the past the two specialties were relatively siloed, and now we're working much closer together. I think that's another benefit for patients because you know our goal is to take care of the patients. There's a lot more collegiality and working a lot better collaboratively with structural heart cardiologists, and I think it all came about through TAVR.

45 Cardiologists, Cardiology Leaders On The Move In 2024

Mariah Taylor (Email) - Updated Friday, March 29th, 2024

Here are 45 cardiologists and cardiology leaders stepping into new roles in 2024:

Andrew Krumerman, MD, was named director of cardiac electrophysiology at Northern Westchester Hospital in Mount Kisco, N.Y.

Cape Girardeau, Mo.-based Mercy Southeast welcomed Raphael Ngengwe, MD, who specializes in cardiac electrophysiology.

OhioHealth Mansfield Hospital appointed Jennifer Dickerson, MD, as lead physician of its heart and vascular team.

Houston Methodist Cardiology Associates at Sugar Land (Texas) is adding Wafi Momin, DO, to its staff.

Kapil Yadav, MD, will lead the Little Rock-based University of Arkansas for Medical Sciences' Nuclear Cardiology and Vascular Medicine Program.

Priscilla Hsue, MD, was named chief of the division of cardiology at Los Angeles-based UCLA Health.

Los Angeles-based UCLA welcomed Priscilla Hsue, MD, as chief of the division of cardiology, effective July 1.

Wayne Franklin, MD, was appointed senior vice president of the Washington, D.C.-based Children's National Heart Center, effective in June.

Webster City, Iowa-based Van Diest Medical Center welcomed cardiologist Kasaiah Makam, MD.

Little Rock-based University of Arkansas for Medical Sciences' department of internal medicine and cardiovascular medicine added cardiologist Michael Luna, MD, as a professor.

Fayetteville, N.C.-based FirstHealth Physician Group appointed William Harris, MD, as its medical director of cardiology.

Laguna Hills, Calif.-based MemorialCare Saddleback Medical Center named Michael Krychman, MD, medical director of women's health services.

Raleigh, N.C.-based Independence Health System welcomed Justin Wallace, MD, to its team.

Los Angeles-based Keck Medicine of USC named Sukgu Han, MD, chief of the division of vascular surgery and endovascular therapy.

Maui, Hawaii-based Pacific Permanente Group welcomed interventional cardiologist Jason Call, MD.

Rohinton Morris, MD, chief of the cardiothoracic surgery division at Philadelphia-based Jefferson Health, will become Tower Health's cardiothoracic surgery chief on April 15.

Point Pleasant, W.Va.-based Rivers Health added George Linsenmeyer, MD, to its staff.

Jacksonville, Fla.-based Wolfson Children's Hospital and the C. Herman and Mary Virginia Terry Heart Institute welcomed four pediatric heart specialists:

Pediatric interventional cardiologist Ram Bishnoi, MD

Pediatric electrophysiologist Judy Ashouri, MD

Pediatric cardiac intensivist Kaushal Dosani, MD

Pediatric cardiologist and cardiac imaging specialist Umakumaran Ponniah, MD

Valdosta, Ga.-based SGMC Health welcomed cardiothoracic surgeon Patrick Murrah, MD, to the health system.

Weill Cornell Medicine and NewYork-Presbyterian Komansky Children's Hospital, both based in New York City, appointed Bernhard Kühn, MD, chief of the division of cardiology in the department of pediatrics.

Eman Rashed, MD, PhD, has joined the advanced heart failure treatment and transplant team at Newark Beth Israel Medical Center in New Jersey.

Interventional cardiologist Charles Mayes Jr., MD, is set to join Dothan, Ala.-based Southeast Health Medical Group's cardiology team in July.

Jennifer Romano, MD, a congenital heart surgeon at Congenital Heart Center/C.S. Mott Children's Hospital in Ann Arbor, Mich., was elected president of The Society of Thoracic Surgeons.

UP Health System-Marquette (Mich.), a Duke LifePoint hospital, welcomed Chris Liakonis, DO, a cardiothoracic surgeon, to its Heart & Vascular Center.

Aurora-based Children's Hospital Colorado appointed Shelley Miyamoto, MD, head of pediatric cardiology.

Lisa Weiss Forbess, MD, joined the Miami-based Baptist Health Miami Cardiac & Vascular Institute.

Oskaloosa, Iowa-based Mahaska Health added John Pargulski, DO, to its team of cardiologists.

Los Angeles-based Smidt Heart Institute's David Ouyang, MD, was named a deputy editor of NEJM AI.

Ridgewood, N.J.-based Valley Health System appointed Suneet Mittal, MD, chair of the cardiovascular service line for the system.

Oskaloosa, Iowa-based Mahaska Health welcomed cardiologist John Pargulski, MD, to its team.

Satya Shreenivas, MD, has been appointed chief medical officer of Cardiac Dimensions, a medical equipment manufacturing company focusing on minimally invasive treatment options for patients who have heart failure with functional mitral regurgitation.

Michelle Bloom, MD, was named system director of the cardio-oncology program at NYU Langone Health in New York City.

Dimitrios Bliagos, MD, has been appointed director of interventional cardiology at NYU Langone Hospital Long Island in Mineola, N.Y.

Humble, Texas-based Modern Heart and Vascular Institute welcomed Mayank Agarwal, MD, to the team.

Cardiothoracic surgeons Nestor Dans, MD, and Nathaniel Kister, MD, joined the Morgantown, W.Va.-based WVU Department of Cardiovascular and Thoracic Surgery.

Sylvania, Ga.-based Optim Medical Center-Screven welcomed David Lariscy, MD, to its team.

Peoria, Ill.-based OSF Healthcare welcomed interventional cardiologist Ameer Musa, MD, to its team.

Kearney, Neb.-based CHI Health Clinic Heart Institute added two interventional cardiologists to its staff: Hermang Panchal, MD, and John Waters, MD.

Deb Kiser, BSN, RN, was named executive lead of the new cardiovascular partnership between Dayton, Ohio-based Premier Health and The Christ Hospital Health Network.

Signs of Pulmonary Embolism